| Doctor Name: | DR. MARIAN R FULLER |
| NPI Number: | 1225053366 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | MF079496 |
| Business Practice Address: | 1293 E Parkdale Ave Suite 1200a Manistee, MI - 496608904 |
| Business Phone Number: | 2313981550 |
| Business Fax Number: | 2313981691 |
| Mailing Address: | 315 Oakgrove St, MANISTEE |
| State: | MI |
| Postal Code: | 496601176 |
| Phone Number: | 2313989266 |
| Fax Number: | 2313989268 |
| NPI Enumeration Date: | 07/12/2006 |
| NPI Last Update Date: | 04/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207VX0000X |
| License Number: | MF079496 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | Obstetrics |
| Taxonomy Definition: | |